Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2966

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-40862719

Registrant Name (Full Legal Name no abbreviations): Syngenta Canada Inc.

Address: 140 Research Lane, Research Park

City: Guelph

Prov / State: Ontario

Country: Canada

Postal Code: N1G4Z3

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

09-JUN-15

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

07-JUN-15

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

---

PMRA Registration No. 19346      PMRA Submission No.       EPA Registration No.

Product Name: Tilt 250E Fungicide

• Active Ingredient(s)
  • PROPICONAZOLE

---

PMRA Registration No. 29544      PMRA Submission No.       EPA Registration No.

Product Name: BARRICADE SG

• Active Ingredient(s)
  • THIFENSULFURON-METHYL
  • TRIBENURON-METHYL

---

PMRA Registration No. 28887      PMRA Submission No.       EPA Registration No.

Product Name: Simplicity

• Active Ingredient(s)
  • PYROXSULAM

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unknown

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Loss of coordination
  • Specify - Uncoordinated

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Sore throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Dizziness

• Gastrointestinal System
  • Symptom - Nausea

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - difficulty sleeping due to cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - Trouble sleeping because of cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - trouble sleeping due to cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - Trouble sleeping due to cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - Trouble sleeping due to cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Gastrointestinal System
  • Symptom - Sore throat

• General
  • Symptom - Insomnia
  • Specify - Trouble sleeping due to cough

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporters wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporters symptoms had resolved other than an intermittent scratchy throat. The reporters six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporters wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporters brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Loss of coordination

• Gastrointestinal System
  • Symptom - Sore throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-40862719 - The reporter, a farmer, indicated that his family was exposed to a fungicide containing the active ingredient propiconazole and to non-registrant products named Barricade and simplicity with unknown active ingredients. The reporter indicated that four days prior to initial contact with the registrant the neighboring farmer applied these products south of his property and during application there was a strong northerly wind and a lot of mist contacted his property and his family inhaled the fumes. Caller states that since the exposure his 6 children have all developed a scratchy throat and a hacking cough that has kept them awake at night. The reporter, his wife, and his brother developed a headache and felt nauseous. The reporter¿¿¿¿¿¿s wife also became dizzy. The reporter and his brother also developed a cough, a scratchy throat and they have been bumping into things (uncoordinated). On follow-up call, six days later the reporter indicated that he went to the doctor but no treatment was offered. At the time of the follow-up call the reporter¿¿¿¿¿¿s symptoms had resolved other than an intermittent scratchy throat. The reporter¿¿¿¿¿¿s six children had a cough and scratchy throat for a period of about 4 days. None of the children were brought to the doctor. The reporter¿¿¿¿¿¿s wife did not seek medical attention and her symptoms lasted for a period of about 4-5 days. The reporter¿¿¿¿¿¿s brother did not seek medical attention and his symptoms were improving at the time of the follow-up call. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.